What helps a toothache until you see the dentist?
A severe toothache needs prompt attention and an accurate diagnosis of its source: pain relievers ease the pain but do not treat the cause. Until your appointment, ask a pharmacist which pain reliever and dose are right for you. According to the American Dental Association (ADA), in adults without contraindications, non-opioid pain relievers, in particular nonsteroidal anti-inflammatory drugs (NSAIDs), are generally the first choice for acute dental pain.
You can rinse your mouth with lukewarm water and gently floss out any food stuck between your teeth. Do not put a pain-relief tablet directly on the painful tooth or gum, as it can burn the tissue, and do not give numbing gels to babies or toddlers without a doctor's advice.
Antibiotics do not replace treating the tooth itself (see the FAQ below).
When to seek care right away
- Fever or feeling generally unwell along with the toothache.
- Swelling spreading to the cheek, the eye or the neck.
- Difficulty swallowing or breathing.
In these cases, go to a hospital emergency room immediately. Without these signs, a severe toothache is seen at the clinic the same day, during opening hours.
Toothache or tooth sensitivity: what is the difference?
A true toothache comes from an active problem in the pulp or the supporting tissues and lasts beyond the trigger, whereas tooth sensitivity is a brief, sharp reaction to cold, heat or sweets.
| Criterion | True toothache | Tooth sensitivity |
|---|---|---|
| Feeling | Sharp, throbbing or constant | Brief, sharp reaction to a trigger |
| Source | The pulp or the supporting tissues | Exposed dentinal tubules |
| Causes | Pulp inflammation, infection at the root tip, significant damage to the tooth | Enamel wear, gum recession, some dental procedures |
| Duration | Lasts beyond the trigger, may worsen at night or lying down | Brief but sharp discomfort |
Diagnosis relies on pulp vitality tests and X-rays, with 3D imaging (CBCT) at the clinic when needed, which help distinguish, for example, an infection under a crown from other problems such as an impacted wisdom tooth, which can cause referred pain.
Common causes of tooth pain
Tooth pain has varied causes, and several can be present at the same time.
Advanced tooth decay
The most common cause is advanced tooth decay that reaches the deep dentin or the pulp and triggers strong inflammation. Bacteria and their toxins irritate the sensitive pulp and raise the pressure inside the tooth, causing intense, throbbing pain. Treatment is usually a root canal or, in some cases, an extraction.
Advanced gum disease
Advanced gum disease (periodontitis) can also cause significant pain, especially when deep pockets or gum abscesses form. Treatment involves deep professional cleaning of the pockets and root surfaces, sometimes with additional medication decided by the dentist, with the aim of keeping the natural tooth.
Severe toothache: where does the pain come from?
Finding the exact source of an intense toothache can be difficult and requires a systematic assessment. The pain may come from one specific tooth, or be referred from elsewhere: the jaw joint, the sinuses or even nerve problems. The dentist assesses the pattern of the pain, its intensity, how long it lasts and what makes it better or worse, and X-rays reveal fine fractures, hidden decay or problems at the root tip that are not visible in the exam.
One cause of intense pain is irreversible pulpitis: the pulp is acutely inflamed and cannot recover without a root canal. The pain can be spontaneous, very strong and made worse by temperature changes, and it may spread to nearby areas, making it hard to tell which tooth is involved.
An acute abscess at the root tip, on the other hand, causes local swelling, extreme tenderness to touch or biting, and sometimes fever and a general feeling of being unwell. This requires an urgent dental visit.
Toothache at night is often linked to increased blood pressure in the head when lying down, which raises the pressure inside the tooth and makes the pain worse. This is typical of active pulp inflammation or a developing infection at the root tip, and often calls for emergency dental treatment. Urgent cases are seen at the clinic the same day during opening hours: treatment combines immediate pain relief with a long-term solution to the underlying problem.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
Treating tooth pain caused by decay
Treatment depends on how deep the decay has gone and whether the pulp is involved.
Shallow decay
Decay limited to the enamel can be treated conservatively, with fluoride or remineralizing products. Once it reaches the dentin, the decayed tissue is removed and the tooth restored, keeping as much healthy structure as possible.
Decay near the pulp
When decay approaches or reaches the pulp, conservative treatments such as direct or indirect pulp capping are considered, especially in young teeth with a healthy pulp. With an advanced cavity and significant pulp involvement, a root canal becomes unavoidable.
The final restoration
Teeth that have had a root canal tend to be more fragile, mainly because of the structure lost to decay and to the access opening. They are often restored with a crown or a ceramic onlay covering the cusps.
Treating tooth pain caused by gum disease
Advanced gum disease (periodontitis) requires step-by-step, comprehensive treatment. It destroys the structures that support the tooth, including the bone, the periodontal ligament and the root surface. The first stage removes the bacterial cause through scaling and root planing, sometimes under local anesthesia, with ultrasonic and hand instruments.
In advanced cases, gum surgery may be needed to reduce deep pockets or regenerate lost tissue (see periodontist in Jerusalem). Successful gum treatment depends on the patient's daily oral hygiene afterwards, including flossing, interdental brushes and a good toothbrush.
Severe toothache from a broken or cracked tooth
Fractures and fine cracks are a diagnostic challenge, because they are not always visible in a routine exam or on standard X-rays.
01
Visible or hidden fractures
Fractures can be visible, such as a traumatic break of the crown, or hidden, as in cracked tooth syndrome, where a crack runs through the dentin and may reach the pulp. Typical symptoms are sharp pain when biting or releasing the bite, sensitivity to temperature, and intermittent pain that is hard to locate. Diagnosis relies on a careful exam with magnification, bite tests and sometimes a dye.
02
Treating a cracked tooth
Treatment depends on the position, direction and depth of the crack. Cracks limited to the crown can be treated with a restoration or a full crown that keeps the crack from spreading. When the crack reaches the pulp, a root canal comes first. Vertical fractures into the root have a poorer outlook and may require extraction and replacement with a dental implant or a bridge.
03
Precise restorations
Restorations are adapted to the shape of the remaining tooth, using modern materials such as reinforced composites or zirconia, with each treatment balancing aesthetics, function and durability. For a chipped or broken tooth, see the dedicated page.
If dental visits make you anxious, read about dental anxiety; if you are pregnant, see dental care during pregnancy: treatment for pain should not be postponed.
Toothache: frequently asked questions
Until your appointment, ask a pharmacist which pain reliever and which dose suit you. According to the American Dental Association, in adults without contraindications, non-opioid pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) are generally the first choice for acute dental pain. Rinsing with lukewarm water and gently flossing out trapped food can also help. Pain relievers do not treat the cause, so book an examination soon.
A severe or persistent toothache should be examined by a dentist soon, especially if it wakes you up, comes with swelling or follows a blow to the tooth. Fever, swelling spreading toward the eye or neck, or difficulty swallowing or breathing require going to a hospital emergency room immediately.
A toothache often gets worse at night mainly because lying down increases blood flow to the head, which raises the pressure inside the tooth and intensifies the pain. This is typical of active inflammation of the pulp or a developing infection at the root tip, and it calls for an urgent dental examination.
Spontaneous, intense tooth pain that gets worse with heat or cold and lasts after the trigger is gone usually points to irreversible inflammation of the pulp (irreversible pulpitis). The pulp cannot recover, and the treatment is a root canal or an extraction, not antibiotics.
In most cases of toothache, pulp inflammation or a localized abscess, the main treatment is dental treatment (a root canal, drainage or an extraction), not antibiotics. According to ADA guidelines, antibiotics are considered when there are general signs such as fever or feeling unwell, and they are prescription-only.
Sources
- Carrasco-Labra A et al., Journal of the American Dental Association, 2024 – View the study
- Lockhart PB et al., Journal of the American Dental Association, 2019 – View the study
- American Dental Association (MouthHealthy), Dental Emergencies – View the page
- U.S. Food and Drug Administration, Safely Soothing Teething Pain in Infants and Children, 2024 – View the page
